| NPI | 1801024799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 1676) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101018232) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2014-06-03 |